NPIMap

Organization Active NPI

Otterbein at Granville

  • Skilled Nursing Facility
  • Granville, OH
National Provider Identifier
1003974023
Registry record updated Dec 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2424N Issued in OH
Legal business name
OTTERBEIN AT GRANVILLE
Practice address
2158 Columbus Rd
Granville, OH 43023-1242
Phone
(740) 587-2840
Fax
(740) 321-0485
NPI assigned
Dec 4, 2006
Last updated
Dec 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Douglas P Helman
Title
Executive Director
Phone
(740) 587-2840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2424N OH Primary

Addresses

Primary practice location

2158 Columbus Rd
Granville, OH 43023-1242

Mailing address

2158 Columbus Rd
Granville, OH 43023-1242
Phone (740) 587-2840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050216000683 OH Part A Provider - Skilled Nursing Facility 4183676224 Practice locations: Granville, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003974023. Details of each certification follow.

Skilled nursing facility certification: CCN 366314

Legal name
OTTERBEIN AT GRANVILLE
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Jun 24, 2005
Last certification
May 29, 2025
Beds
22
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Otterbein SeniorLife
Organization structure
CorporationNon-profit
Incorporated
Jan 14, 1999 in OH
Enrollment address
2158 Columbus Rd
Granville, OH 43023-1242
Nursing home name
OTTERBEIN AT GRANVILLE
Affiliated entity
OTTERBEIN SENIORLIFE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Otterbein at GranvilleCCN 366314 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
Jun 24, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
2220.6 residents per day on average
Chain
Otterbein Seniorlife20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1035835Otterbein at Granville2158 Columbus Road, Granville, OH 43023Certificate of waiverJan 11, 2027

National Provider Directory

National Provider Directory

Networks

  • OH PPO

Ownership & related parties

All disclosed owners & managing parties 33

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Becky Bayliff Individual Operational/Managerial Control Dec 1, 2021
Polaris Pharmacy Services of Ohio LLC Organization, Columbus, OH LLC, Medical provider/supplier, Consulting firm, For-profit Adp of the SNF Dec 1, 2018
Jason E Miller Individual Corporate OfficerChief Operating Officer Dec 1, 2021
Greg Sharkey Individual Managing Control - Governing BodyBoard Member Jan 1, 2021
Trustee of the SNF Jan 1, 2021
Heidi Glosser Individual Operational/Managerial Control Dec 1, 2021
Derik R Kroeze Individual Operational/Managerial Control Nov 13, 2017
Adp of the SNF Nov 13, 2017
Victoria Bartlett Individual Operational/Managerial Control Dec 1, 2021
Richard Johnston Individual Managing Control - Governing BodyBoard Member May 1, 2017
Trustee of the SNF May 1, 2017
Christie Vargo Individual Managing Control - Governing BodyBoard Member Jan 1, 2021
Trustee of the SNF Jan 1, 2021
William Brownson Individual Corporate DirectorBoard Member Dec 1, 2021
Operational/Managerial Control Dec 1, 2021
Jennifer Weekly Individual Corporate DirectorHLTH SVCS Admin Nov 9, 2004
Todd Ware Individual Managing Control - Governing BodyBoard Member Dec 1, 2021
Trustee of the SNF Dec 1, 2021
Rita C Hawkins Individual Corporate OfficerAvp Finance Jan 16, 2006
Tomas Hazelbaker Individual Operational/Managerial Control Dec 1, 2021
Andy Crawford Individual Managing Control - Governing BodyBoard Member Jan 1, 2020
Trustee of the SNF Jan 1, 2020
Talya R Greathouse Individual Managing Control - Governing BodyBoard Member Jan 1, 2016
Trustee of the SNF Jan 1, 2016
Jonathan Hollister Individual Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 1, 2021
Ralph Reed Fraley Individual Operational/Managerial Control Dec 1, 2021
Anne Peterson Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Trustee of the SNF Jan 1, 2023
Otterbein LSC, LLC Organization, Lebanon, OH LLC, Holding company, Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2023 100%
Functional Pathways of Tennessee LLC Organization, Knoxville, TN LLC, Medical provider/supplier, Medical staffing company, For-profit Operational/Managerial Control Dec 1, 2018
Adp of the SNF Mar 25, 2025
Jill Wilson Individual Corporate OfficerPresident & Ceo May 1, 2009
Connie Hawk Individual Managing Control - Governing BodyBoard Member Jan 1, 2020
Trustee of the SNF Jan 1, 2020
Stephen Layman Individual Managing Control - Governing BodyBoard Member Dec 1, 2021
Trustee of the SNF Dec 1, 2021
Otterbein Home Organization, Lebanon, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 1, 2021 100%
Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 1, 2021
James Christopher Green Individual Corporate OfficerVP Finance/Treasurer/Cfo Dec 1, 2021
Nancy Neely Individual Managing Control - Governing BodyBoard Member Dec 1, 2021
Trustee of the SNF Dec 1, 2021
Robert Coleman Individual Operational/Managerial Control Dec 1, 2021
Dale Lewellen Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Trustee of the SNF Jan 1, 2025
Daniel Burke Individual Operational/Managerial Control Dec 1, 2021
Lynn App Individual Operational/Managerial Control Dec 1, 2021
Steve Vonderhaar Individual Operational/Managerial Control Dec 1, 2021
Molly C Ingold Individual Corporate OfficerPresident Jan 1, 2018
Corporate DirectorBoard MBR Jan 1, 2012

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 26

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 26

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672099200000",
    "number": "1003974023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2158 COLUMBUS RD",
            "city": "GRANVILLE",
            "state": "OH",
            "postal_code": "430231242",
            "telephone_number": "740-587-2840",
            "fax_number": "740-321-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 COLUMBUS RD",
            "city": "GRANVILLE",
            "state": "OH",
            "postal_code": "430231242",
            "telephone_number": "740-587-2840",
            "fax_number": "740-321-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERBEIN AT GRANVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A",
        "authorized_official_last_name": "HELMAN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "740-587-2840"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2424N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granville, OH

Sources for this page

Verify at the official NPI Registry.